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TEQUESTA, Fla. — On their way home from an SAT tutoring session, the Van Dresser twins, Alexandra and Samantha, 17, popped into Tan Fever & Spa, a small salon tucked into a strip mall between a bar and a supermarket.

They wanted to get tan before the prom, and the salon was the perfect combination of fast and cheap: Twenty minutes in a tanning bed cost $7.

“It’s the quickness of the tanning bed,” Alexandra said one afternoon last year. “We don’t have time to lay out on a beach.”

Indoor tanning might seem like a fashion that faded with the 1980s, but it remains a persistent part of American adolescence, popular spring, summer and fall but especially in winter, when bodies are palest.

Salons with names such as Eternal Summer and Tan City dot strip malls nationwide, promising prettiness and, in some cases, better health, despite a growing body of evidence that links indoor tanning to skin cancer.

In the Sunshine State, there are more tanning salons than McDonald’s restaurants, CVS stores or Bank of America branches, according to a 2014 study by University of Miami researchers.

For decades, researchers saw indoor tanning as little more than a curiosity. But a review of the scientific evidence published last year estimated that tanning beds account for as many as 400,000 cases of skin cancer in the United States each year, including 6,000 cases of melanoma, the deadliest form.

Clinicians are concerned about the incidence rate of melanoma in women younger than 40, which has risen by one-third since the early 1990s, according to data from the National Cancer Institute. (Death rates have not gone up, however, a testament to earlier detection and better treatment.)

“We’re seeing younger and younger patients coming to us with skin cancer,” said Dr. Eleni Linos, assistant professor of dermatology at the University of California, San Francisco. “That is a new phenomenon.”

As such worrying signs have accumulated, tanning has emerged as a serious public-health concern. Last year, the surgeon general called on Americans to reduce their exposure to the sun and tanning beds to prevent skin cancer, and the Food and Drug Administration (FDA) invoked its most serious risk warning, lifting tanning beds from a category that included Band-Aids to that of potentially harmful medical devices. The Obama administration’s 2010 health-care law imposed a 10 percent tax on tanning salons.

Restricted use

More than 40 states, including Washington, have some sort of restriction on the use of indoor-tanning salons by minors, according to AIM at Melanoma, an advocacy and research group based in California, the first state to adopt a ban on minors in 2011. At least nine states — Washington included — plus the District of Columbia (pending congressional approval) have passed such bans.

Washington’s law took effect in 2014 and prohibits people younger than 18 from using ultraviolet-tanning devices such as tanning booths and beds and sunlamps without a doctor’s prescription. Tanners must provide government ID to prove their age, and salon owners face fines as high as $250 for each violation.

For the first time, new federal data has documented a decline in the use of indoor tanning among teenage girls, dropping to about one-fifth of them in 2013, from one-fourth in 2009. Gery Guy Jr., a researcher with the Centers for Disease Control and Prevention (CDC) who analyzed the data, released in December, attributed the decline to greater awareness and tougher laws.

Even so, public-health experts say tanning remains a persistent problem, especially among white teenage girls, one-third of whom say they have tanned indoors, more than the share who smoke cigarettes.

There were about 14,000 salons across the country as of early 2014, according to John Overstreet, executive director of the Indoor Tanning Association. That does not count tanning beds in gyms and beauty parlors. The number is down about one-fifth in recent years, he said, as the recession eroded young women’s disposable income and the tax imposed under the new health-care law squeezed salons’ profits.

Overstreet says there is no science that conclusively links moderate, nonburning ultraviolet-ray exposure to melanoma. His organization’s mission, according to its website, is “to protect the freedom of individuals to acquire a suntan.”

“The folks who don’t like this industry are exaggerating the risks,” he said, adding: “It’s just like anything in life. If you get too much of it, it’s bad for you.”

A cancer link

Evidence of the link between melanoma and ultraviolet (UV) exposure may have been inconclusive a decade ago, but recent research, including fresh data from the Cancer Genome Atlas, a federally funded program that is cataloging genetic mutations responsible for cancer, bolsters the case for the link.

Dr. Jeffrey Gershenwald, a leader of the melanoma Atlas project, said studies to date showed that most melanomas initially arising on the skin contain mutations associated with UV exposure. As for burning, one recent study controlled for that, and still found an increased risk from indoor tanning.

“There’s no longer a question of whether UV is important,” said Gershenwald, medical director of the Melanoma & Skin Center at the University of Texas MD Anderson Cancer Center. “Genomics has been transformative in our understanding of melanoma.”

Many factors, including genetics, are at play with skin cancer. But exposure to UV light causes a majority of cases, and scientists have been trying to gauge how big a role indoor tanning plays.

A panel of experts convened by the World Health Organization found in 2009 that the use of sun beds before age 30 was associated with a 75 percent increase in the risk of melanoma. A 2012 study found a 15 percent increase in the risk of certain skin cancers with every four sessions in a tanning bed before age 35.

Overstreet contends that more people may be finding melanomas because more people are going to the doctor to look for them. Experts say the increase is real, and not just a matter of better detection.

The problem with indoor tanning, researchers say, is that many of those who do it, do it a lot. The federal government has collected data on tanning among high-school students only since 2009, but researchers were surprised at the findings: Among those who used tanning beds, more than half had used them 10 times or more in the past year, according to Guy, the CDC researcher.

There is strong peer pressure to be tan, particularly in small-town high schools.

Sarah Hughes started tanning at 16, during beauty-pageant season in her hometown of Dothan, Ala. She often tanned five days a week.

Over time, she came to crave it.

“People did drugs. People had eating disorders. I tanned,” said Hughes, now 30.

She stopped tanning at 25, when a doctor diagnosed advanced melanoma. A tumor on her left leg had grown down into her muscle and, eventually, her lymph nodes. In all, she had 33 spots removed, including eight melanomas over two years, a searing experience.

She survived.

Craving confidence

Many young women said in interviews that tanning fed a craving to be pretty, at a crucial time in life. Madison, 21, a student at the University of Rhode Island who asked that her last name not be used, said tanning made her feel “more confident and more comfortable when I walk around.”

“Sometimes it makes me feel thinner,” she continued. “It has all these weird effects that just make me feel better about myself.”

Some experts say combating the problem is a matter of raising awareness about the dangers of tanning. But many women said they were aware of health risks but cared more about how they looked now.

“If I get skin cancer I’ll deal with it then,” said Elizabeth LaBak, 22, a student at Westfield State University in Massachusetts. “I can’t think about that now. I’m going to die of something.”

She did say fewer women on campus tan now. “All the Victoria Secret models are pale now,” she added.

Even so, salons persist. About half the country’s top 125 colleges have tanning beds on campus or in off-campus housing, University of Massachusetts medical-school researchers reported in October.

LaBak’s favorite spot, Beach Club Tanning, which offered $2 tans, has closed, and “now there’s no place that’s cheap enough,” she said.

“The tanning thing is like the smoking thing,” she said. “Everyone used to smoke. And then they said, ‘You’ll die of lung cancer.’ That’s what’s happening to tanning.”

Material from The Seattle Times archive is included in this report.